Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus

Bösch, U.; Skutek, Michael; Fremerey, R.; Tscherne, H.

doi:10.1016/s1058-2746(98)90198-7

Cited by 170 publications

(85 citation statements)

References 22 publications

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“…While a few studies reported that non-operative management is associated with poor results [1,2], a recent prospective, but not controlled, trial found it difficult to demonstrate a significant advantage of surgical over non-operative management [3]. Consistent with the findings of the latter study is the observation that the results of various surgical treatments, such as closed reduction and percutaneous pinning [4,5], plate fixation [6,7] and hemiarthroplasty [8], may be unpredictable. However, the fracture pattern, amount of displacement of the fragments, bone stock of the upper humerus, preexisting rotator cuff disease or arthrosis and the patient's age and general condition are important factors in the choice of treatment.…”

Section: Introductionmentioning

confidence: 85%

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Carbone

Tangari

Gumina

et al. 2012

International Orthopaedics (SICOT)

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Purpose Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three-or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP). Methods A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16 weeks, and six months, one year and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods.Results Of the 58 patients, 52 could be evaluated at all follow-ups. In both three-or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p<0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p<0.001). Conclusions The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.

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Section: Introductionmentioning

confidence: 85%

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Carbone

Tangari

Gumina

et al. 2012

International Orthopaedics (SICOT)

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“…In heavily comminuted fractures, i.e., especially in all four-part fractures the recommendation was to directly replace the fractured humeral head by primary arthroplasty [20][21][22][23].…”

Section: Operative Treatmentmentioning

confidence: 99%

Proximal Humeral Fractures: Nailing

Rueger

Rücker

Briem

et al. 2007

Eur J Trauma Emerg Surg

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Treating proximal humeral fractures surgically has always been a challenge for the orthopaedic trauma surgeon. The challenge was and is due to numerous factors such as the specific anatomy of the proximal humerus, problems of an adequate approach and exposure of the fracture and different fracture fragments, possible iatrogenic injuries to the rotator cuff on approach and the detrimental effects of the former on the latter's gliding and contracting ability after surgery. Furthermore, the very different fracture patterns that can occur at the proximal humerus, the shear number of fragments which can be of extremely bad bone quality, the necessity for anatomic reduction of these fragments with an implant that will allow for a stable osteosynthesis and at the meantime will not impinge in the subacromial area and lastly, the intention of the physician-in-charge to commence with physical therapy as soon as possible post OP. All of these added to the fact that not one fixation technique with one certain implant could be recommended as a treatment or implant of choice in dealing with these difficult fractures. Most of the supposedly applicable surgical techniques and implants had major setbacks such as being limited to only very expert hands, necessitating a long-standing postoperative immobilisation, resulting in secondary loosening of implants, secondary loosening of reduction or impaired bone healing and, despite all efforts, finally led to poor function at the shoulder. With the advent of angular stable implants such as angular stable, anatomically contoured plates designed for proximal humeral fractures only and special angular stable nails for the same or similar indications the treatment options and the quality of treatment in this area was much improved. Our experience with angular stable nails of two different manufacturers in now more than 320 implantations reveals that indications for the surgical treatment of such fractures can be extended constantly, that the number of complications will simultaneously decline, the necessity for primary joint arthroplasty even in multiple fragment fractures is minimal and that long-term results are, comparing the published results in the literature with those of our institution, equal if not superior to other treatment options.

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“…Os instrumentos para avaliação funcional do ombro são propostos como um método simplificado para avaliar e comparar o tratamento de várias alterações do ombro (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) . Alguns instrumentos, inicialmente, propuseram avaliar a resposta de certos procedimentos em um grupo específico de pacientes.…”

Section: Introductionunclassified

Tradução e adaptação cultural do Modified-University of California at Los Angeles Shoulder Rating Scale para a língua portuguesa

Oku¹,

Andrade²,

Stadiniky³

et al. 2006

Rev. Bras. Reumatol.

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Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus

Cited by 170 publications

References 22 publications

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Proximal Humeral Fractures: Nailing

Tradução e adaptação cultural do Modified-University of California at Los Angeles Shoulder Rating Scale para a língua portuguesa

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